A 70 year old woman was admitted to hospital with severe breathlessness. On examination her blood pressure was 100/55 mmHg and she had a raised JVP by 4 cm. Chest x ray showed mild pulmonary oedema.
Investigations revealed:
Haemoglobin 6.6 g/dLMCV 108 fL MCH 32.0 pg White cell count 3.0 x 10^9 /L Platelets 75 x 10^9 /L Serum vitamin B12 normalFolate 2 (3-20) µg/l
What should be done?
A. Treat congestive cardiac failure then transfuse
B. Immediate blood transfusion
C. Serum electrophoresis
D. Iron replacement
E. B12 and folate replacement
Do question later!
Answer: e) B12 and folate replacement. Blood transfusion may worsen cardiac failure in this case. In patients who are folate deficient erythropoiesis rapidly resolves when supplements are given, and transfusion is rarely needed in the elderly (unless the anaemia is very severe).
Investigations revealed:
Haemoglobin 6.6 g/dLMCV 108 fL MCH 32.0 pg White cell count 3.0 x 10^9 /L Platelets 75 x 10^9 /L Serum vitamin B12 normalFolate 2 (3-20) µg/l
What should be done?
A. Treat congestive cardiac failure then transfuse
B. Immediate blood transfusion
C. Serum electrophoresis
D. Iron replacement
E. B12 and folate replacement
Do question later!
Answer: e) B12 and folate replacement. Blood transfusion may worsen cardiac failure in this case. In patients who are folate deficient erythropoiesis rapidly resolves when supplements are given, and transfusion is rarely needed in the elderly (unless the anaemia is very severe).
posted by betty chan at 9:23 PM
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